Namimi-Halevi Chen, Keinan-Boker Lital, Dichtiar Rita, Beckerman Pazit, Bromberg Michal
Department of Epidemiology and Preventive Medicine, School of Public Health, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Israel Center for Disease Control, Israel Ministry of Health, Sheba Medical Center, Tel Hashomer, 5265601, Ramat Gan, Israel.
J Community Health. 2025 Jul 1. doi: 10.1007/s10900-025-01496-0.
Evidence on the association between dialysis facility accessibility and mortality in small countries is limited. This study evaluated the association between travel distance and one- and two-year mortality among Israeli end-stage renal disease (ESRD) patients. Data were obtained from the National Renal Replacement Therapy Registry, encompassing all Israeli ESRD patients aged ≥ 45 years who initiated hemodialysis in 2010-2021. Sociodemographic (age, sex, population group), treatment-related (hospital/community treatment, primary renal disease, incident-year cohort), and geographic (residency socioeconomic and peripherality indices) data were collected. Travel distances from the most recent address to the initial treating facility were categorized into three groups based on the 50th and 90th percentiles, excluding outliers (> 100 km). Adjusted Cox regressions assessed associations between travel distances and mortality, with incident-year cohort-specific models evaluating temporal hazard variations. Analyses included 15,606 patients. The long-distance group (> 26.39 km) was characterized by younger age, Arab ethnicity, peripheral residence, and lower socioeconomic status. Compared to the short-distance group (≤ 6.80 km), the hazard ratios (HRs) in the intermediate-distance group (> 6.80 and ≤ 26.39 km) were 1.216 (1.106-1.337) for one-year and 1.181 (1.093-1.275) for two-year mortality. In the long-distance group, the HRs were 1.718 (1.460-2.021) for one-year and 1.554 (1.351-1.787) for two-year mortality (P-for-trend between travel distances <.001). Sensitivity and temporal analyses confirmed consistent associations across incident-year cohorts, alternative cut-offs, and outlier inclusion. The association between travel distance and mortality highlights the need to improve geographic accessibility to healthcare to reduce inequities, especially for life-sustaining chronic treatments such as hemodialysis.
关于小国透析设施可及性与死亡率之间关联的证据有限。本研究评估了以色列终末期肾病（ESRD）患者的出行距离与1年和2年死亡率之间的关联。数据来自国家肾脏替代治疗登记处，涵盖2010年至2021年开始进行血液透析的所有年龄≥45岁的以色列ESRD患者。收集了社会人口统计学（年龄、性别、人群组）、治疗相关（医院/社区治疗、原发性肾病、发病年份队列）和地理（居住社会经济和周边性指数）数据。从最近住址到初始治疗设施的出行距离根据第50和第90百分位数分为三组，排除异常值（>100公里）。调整后的Cox回归评估出行距离与死亡率之间的关联，特定发病年份队列模型评估时间风险变化。分析纳入了15606名患者。长途组（>26.39公里）的特征为年龄较小、阿拉伯族裔、居住在周边地区且社会经济地位较低。与短途组（≤6.80公里）相比，中长途组（>6.80公里且≤26.39公里）1年死亡率的风险比（HR）为1.216（1.106 - 1.337），2年死亡率的HR为1.181（1.093 - 1.275）。在长途组中，1年死亡率的HR为1.718（1.460 - 2.021），2年死亡率的HR为1.554（1.351 - 1.787）（出行距离之间的P趋势<0.001）。敏感性和时间分析证实了不同发病年份队列、替代临界值和异常值纳入情况下的一致关联。出行距离与死亡率之间的关联凸显了改善医疗保健地理可及性以减少不平等的必要性，特别是对于血液透析等维持生命的慢性治疗。
